Seroprevalence of Hepatitis E among Boston Area Travelers, 2009-2010

We determined the prevalence of IgG antibodies to hepatitis E virus (anti-HEV IgG) among travelers attending Boston-area travel health clinics from 2009 to 2010. Pre-travel samples were available for 1,356 travelers, with paired pre- and post-travel samples for 450 (33%). Eighty of 1,356 (6%) pre-travel samples were positive for anti-HEV IgG. Compared with participants who had never lived in nor traveled to a highly endemic country, the pre-travel prevalence odds ratio (POR) of anti-HEV IgG among participants born in or with a history of previous travel to a highly endemic country was increased (POR = 4.8, 95% CI = 2.3–10.3 and POR = 2.6, 95% CI = 1.4–5.0, respectively). Among participants with previous travel to a highly endemic country, anti-HEV IgG was associated with age > 40 years (POR = 3.7, 95% CI = 1.3–10.2) and travel history to ≥ 3 highly endemic countries (POR = 2.7, 95% CI = 1.2–5.9). Two participants may have contracted HEV infection during their 2009–2010 trip

Measuring health outcomes, experience of care and cost of healthcare in student-led healthcare services: a literature review

Introduction: In student-led healthcare services, health students take responsibility for the management and delivery of health services as part of clinical training. Like all healthcare services, student-led healthcare services need to be evaluated to ensure they provide high quality, safe and cost-effective services. The aim of this literature review was to understand how student-led healthcare services have been evaluated to date, and to assess alignment of previous evaluations with the Triple Aim framework. The Triple Aim is a conceptual framework, offering a systematic approach to evaluating healthcare services that may be appropriate for evaluation of student-led services. Methods: Electronic databases were searched for articles describing a student-led healthcare service and were screened for studies that evaluated the impact of a student-led healthcare service on patient outcomes. Results: Fourteen of 211 identified articles met the inclusion criteria. All 14 studies met the Triple Aim measurement principles of “a defined population,” “gather data over time” and “distinguish between measures” while only eight of the 14 studies achieved “comparison data”. All 14 studies measured at least one or more of the Triple Aim dimensions. Discussion/Conclusion: There was little consistency across the evaluations of student-led healthcare services, limiting the extent to which the benefits of student-led healthcare services can be shown to be a valuable resource to the healthcare system. Further investigation is required to determine a suitable evaluation framework for student-led healthcare services

An Educational Video Intervention to Increase Advance Care Planning Knowledge and Advance Directive Completion for Community-Dwelling Veterans

Approved July 2017 by the faculty of UMKC in partial fulfillment of the requirements for the degree of Doctor of Nursing PracticeAdvance Care Planning is the process by which patients with the healthcare provider and family establish values, goals, and preferences for future care. Advance Directives provide written documentation of patients wishes for future care following Advance Care Planning conversations. The problem exists that only 17% of adults have had Advance Care Planning discussions with a healthcare provider and 18-36% have completed an Advance Directive. Lack of knowledge and awareness regarding ACP is the most common reason people have not completed an Advance Directive. The purpose of this quasi-experimental Doctor of Nursing Practice pilot project was to determine if an educational video intervention increased Advance Care Planning knowledge and Advance Directive completion in 30 community-dwelling Veterans whom are members of American Legion or Veterans of Foreign War Posts. Videos from the Nous Foundation were utilized for this educational intervention. Veterans were administered a questionnaire before and after the educational video intervention. This study supported the use of an educational video intervention to increase Advance Care Planning knowledge and increase participants plan to complete an Advance Directive. The implementation of this pilot project benefits the physical, psychological, psychosocial, spiritual, and financial well-being of patients, families, providers, healthcare organizations, and society

Self-reported illness among Boston-area international travelers: A prospective study

This is the Accepted Manuscript version and was published in final edited form as: Travel Med Infect Dis. 2016 ; 14(6): 604–613. doi:10.1016/j.tmaid.2016.09.009.BACKGROUND: The Boston Area Travel Medicine Network surveyed travelers on travel-related health problems. METHODS: Travelers were recruited 2009-2011 during pre-travel consultation at three clinics. The investigation included pre-travel data, weekly during-travel diaries, and a post-travel questionnaire. We analyzed demographics, trip characteristics, health problems experienced, and assessed the relationship between influenza vaccination, influenza prevention advice, and respiratory symptoms. RESULTS:Of 987 enrolled travelers, 628 (64%) completed all surveys, of which 400 (64%) reported health problems during and/or after travel; median trip duration was 12 days. Diarrhea affected the most people during travel (172) while runny/stuffy nose affected the most people after travel (95). Of those with health problems during travel, 25% stopped or altered plans; 1% were hospitalized. After travel, 21% stopped planned activities, 23% sought physician or other health advice; one traveler was hospitalized. Travelers who received influenza vaccination and influenza prevention advice had lower rates of respiratory symptoms than those that received influenza prevention advice alone (18% vs 28%, P = 0.03). CONCLUSIONS:A large proportion of Boston-area travelers reported health problems despite pre-travel consultation, resulting in inconveniences. The combination of influenza prevention advice and influenza immunization was associated with fewer respiratory symptoms than those who received influenza prevention advice alone

Travelers’ diarrhea and other gastrointestinal symptoms among Boston-area international travelers

INTRODUCTION: Travelers' diarrhea (TD) and non-TD gastrointestinal (GI) symptoms are common among international travelers. In a study of short-term travelers from Switzerland to developing countries, the most common symptom experienced was severe diarrhea (8.5%) followed by vomiting or abdominal cramps (4%).1 GI illnesses were the most frequently reported diagnoses (34%) among ill-returned travelers to GeoSentinel clinics.2 Of those returning to U.S. GeoSentinel clinics, acute diarrhea (30%) was the most common diagnosis.3 In one cohort of U.S. travelers, 46% reported diarrhea.4 GI illnesses can last from 2 days to weeks or longer,5 disrupting plans during travel or after returning home. Eighty percent of those who experienced diarrhea during travel treated themselves with medication and 6% sought medical care. METHODS: The Boston Area Travel Medicine Network (BATMN) is a research collaboration of travel clinics in the greater Boston area representing urban-, suburban-, academic-, and university-affiliated facilities. A convenience sample of travelers ≥ 18 years of age attending three BATMN clinics between 2009 and 2011 for pre-travel consultations completed pre-travel surveys, at least one survey weekly during travel, and a post-travel survey 2–4 weeks after return. Travelers were asked to complete a survey at the end of each week of their trip. Institutional review board approvals were obtained at all sites and the Centers for Disease Control and Prevention, and participants provided written informed consent. Information collected included demographic and trip characteristics, vaccines and medications recommended/prescribed before travel, medications taken during travel, dietary practices during travel (consumption of tap water, ice in drinks, unpasteurized dairy products, and salads), symptoms experienced, and impact of illness during and after travel. Vaccinations, prescriptions, and travel health advice given during the pre-travel consultation were recorded by a clinician, and the remainder of the surveys were completed by the traveler. Data were entered into a password-protected database (CS Pro, U.S. Census Bureau, Washington, DC). RESULTS: We enrolled 987 travelers; 628 (64%) completed all three parts (pre-, during, and post-travel) and were included in the study. Comparison of the 628 to the 359 who did not complete all three parts (noncompleters) revealed no differences, except that completion rates were higher for white travelers than all other racial/ethnic groups (P < 0.001) and for older travelers (median age 47 years versus 32 years in noncompleters, P < 0.001).11 Of those 628 travelers, 208 (33%) experienced TD, 45 (7%) experienced non-TD GI symptoms, 147 (23%) experienced non-GI symptoms, and 228 (36%) did not experience any symptoms during or after travel. Of the 208 with TD, 140 (67%) reported diarrhea as their only symptom, whereas 33 (16%) also experienced nausea/vomiting, 23 (11%) abdominal pain, and 27 (13%) fever (Table 1). Of the 45 who reported non-TD GI symptoms, 21 (47%) experienced nausea/vomiting, 19 (42%) experienced constipation, and 10 (22%) experienced abdominal pain during or after travel (Table 2). Almost all travelers (99%) received advice about food and water precautions and diarrhea management during pre-travel consultation

Realising the benefits of integrated data for local policymaking: Rhetoric versus reality

This article presents findings from local government projects to realise the benefits of big data for policy. Through participatory action research with two local statutory authorities in the South West of England, we observed the activities of identifying, integrating and analysing multiple and diverse forms of data, including large administrative datasets, to generate insights on live policy priorities and inform decision-making. We reveal the significance of both data production and policymaking contexts in explaining how big data of this kind can be called upon and enacted in policy processes

Ionomer content optimization in nickel-iron-based anodes with and without ceria for anion exchange membrane water electrolysis

Hydrogen production from anion exchange membrane water electrolysis (AEMWE) is an efficient cost-effective solution to renewable energy storage. Contrary to proton exchange membrane (PEM) electrolysis, AEMWE requires further optimization of its cell design, particularly for the kinetically unfavourable oxygen evolution anode half-cell reaction (OER). In this work we optimize the commercial Fumatech fumion ionomer content in AEMWE anodes using nickel (Ni) nanoparticles (NP) synthesized by chemical reduction. The optimal ionomer content is then applied to Ni-iron (Fe)-based NPs with and without ceria (CeO2), all prepared using the same method. Scanning Electron Microscopy (SEM) of the resulting electrode surfaces, Particle-size Distribution (PSD) of the catalyst inks, and in-situ testing of the monometallic Ni NPs show that the best and most active catalytic layer is obtained using 15 wt% ionomer. AEMWE performance and short-term durability are evaluated in different concentrations of potassium hydroxide (KOH), where the Ni90Fe10 is the best performing Ni-based electrode showing 1.72 V at 0.8 A cm−2 in 1 M KOH after IR-correction, and a degradation rate of 3.3 mV h−1. The addition of ceria to the Ni-based catalysts shows more consistent mass transfer over time likely due to more efficient water transport and bubble release.acceptedVersio

Species Tropism of Chimeric SHIV Clones Containing HIV-1 Subtype-A and Subtype-E Envelope Genes

AbstractTo analyze HIV-1 genes in a nonhuman primate model for lentivirus infection and AIDS, recombinant SIV/HIV-1 (SHIV) clones were constructed from two HIV-1 subtype-A isolates (HIV-1SF170 and HIV-1Q23–17 from individuals in Africa) and two HIV-1 subtype-E isolates (HIV-19466 and HIV-1CAR402 from AIDS patients in Thailand and Africa), respectively. These four SHIV clones, designated SHIV-A-170, SHIV-A-Q23, SHIV-9466.33, and SHIV-E-CAR, contain envelope (env) genes from the subtype-A or -E viruses. Interestingly, SHIV-A-170, SHIV-A-Q23, and SHIV-9466.33 were restricted for replication in cultures of macaque lymphoid cells, whereas SHIV-E-CAR replicated efficiently in these cells. Additional studies to define the block to replication in macaque cells were focused on the subtype-E clone SHIV-9466.33. A SHIV intragenic env clone, containing sequence-encompassing V1/V2 regions of HIV-1CAR402 and V3/V4/V5 regions of SHIV-9466.33, infected and replicated in macaque lymphoid cells. These results indicated that the sequence-encompassing V1/V2 region of HIV-19466 was responsible for the block of the SHIV-9466.33 replication in macaque cells. Analysis of viral DNA in acutely infected macaque cells revealed that SHIV-9466.33 was blocked at a step at/or before viral DNA synthesis, presumably during the process of virion entry into cells. In a fluorescence-based cell–cell fusion assay, fusion pore formation readily took place in cocultures of cells expressing the SHIV-9466.33 env glycoprotein with macaque T-lymphoid cells. Taken together, these results demonstrated that the block of SHIV-9466.33 replication in macaque cells is at an early step after fusion pore formation but before reverse transcription